title: Prevalence and topography of lymph node metastases in early esophageal and gastric cancer.
abstract: OBJECTIVE
  To determine the prevalence and localization of lymph node metastases in patients with pT1 carcinoma of the esophagus, esophagogastric junction, and stomach.
  
  
  BACKGROUND
  Retrospective analysis and topographic description.
  
  
  METHODS
  We included 793 consecutive patients with pT1 carcinomas who underwent primary surgery for squamous cell carcinoma (SCC) of the esophagus, adenocarcinomas of the esophagogastric junction (AEG), or gastric cancer (GC). Clinical records and pathology reports were reviewed, and the prevalence and topography of lymph node metastases were identified.
  
  
  RESULTS
  The prevalence of lymph node metastases in SCC, AEG, and GC was 7%, 0%, and 5% for pT1a tumors and 24%, 18%, and 14% for pT1b tumors, respectively. Positive lymph node status was associated with worse overall survival (P<0.001). Not only infiltration of the submucosa (P=0.002) but also lymphatic vessel invasion (P<0.001), multifocal tumor growth (P=0.001), lower patient age (P=0.001), and poor tumor differentiation (P=0.05) were associated with nodal disease. These 5 parameters allowed the compilation of a nomogram to estimate the individual risk of lymph node metastases. In SCC, lymph node metastases were found from the neck to the celiac axis. In AEG, nodal disease was limited to the lower mediastinum and the D1 compartment. In GC, lymphatic spread exceeded the D1 compartment in 7% of node positive patients.
  
  
  CONCLUSIONS
  Risk estimation for lymph node metastases should not be based on depth of tumor infiltration alone but additional clinicopathological parameters should also be considered. The extent of lymphadenectomy in surgical procedures should respect the presented topography of lymph node metastases.
authors.affiliation: *Chirurgische Klinik und Poliklinik †Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Nürnberg Nord, Nürnberg, Germany ‡Institut für Medizinische Statistik und Epidemiologie; and §Institut für Allgemeine Pathologie und Pathologische Anatomie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gertler
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Stein
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Ina-Christine
authors.initials: IC
authors.lastname: Rondak
authors.forename: Heinz
authors.initials: H
authors.lastname: Höfler
authors.forename: Marcus
authors.initials: M
authors.lastname: Feith
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D055815:Young Adult